Managed Care and People with Severe Mental Illness: Challenges and Opportunities for Social Work

Abstract

The managed care initiatives sweeping the nation are having a profound effect on the way that social workers deliver services to people with severe mental illness. Social work, with its client-focused value base and relevant conceptual frameworks, has an opportunity to provide leadership in this area. To do so, however, social workers must keep abreast of developments in managed care; use efficacy information more systematically; and promote consumer involvement in the design, implementation, and monitoring of managed care programs for people with severe mental illness.

The Premature Demise of Public Child and Adolescent Inpatient Psychiatric Beds

“…Other concerns about managed behavioral health care include limited outpatient visits, decreased emphasis on community-based services, eschewal of psychosocial rehabilitation interventions, insufficient evidence regarding managed-care-sanctioned therapeutic interventions, and the actual cost-effectiveness of managed care techniques themselves [88]. More vulnerable populations may not be well served by a behavioral managed care system, and the costs of serving the severely ill may discourage HMOs from providing high-quality mental health services at all [20,89].…”

The Challenges in Providing Services to Clients with Mental Illness: Managed Care, Burnout and Somatic Symptoms Among Social Workers

“…With the restructuring of mental health services to managed care practices, workers have been dealing with strict practice guidelines, increased accountability, reduced autonomy, and a requirement to become competent with new management skills (Cohen 2003;Feldman 1997;Hall and Keefe 2000;Koeske and Koeske 1993;Lu et al 2002;Shera 1996). Participating in managed care is complicated, and those that are not apprised about the managed care world are likely to suffer of stress and anxiety concerning their ability to perform well and continue providing effective services to their clients (Hall and Keefe 2000;Spevack 2009).…”

“…Participating in managed care is complicated, and those that are not apprised about the managed care world are likely to suffer of stress and anxiety concerning their ability to perform well and continue providing effective services to their clients (Hall and Keefe 2000;Spevack 2009). Perceptions that job activities are inappropriate and incongruent with workers' training and expertise can result in feelings such as disliking the job, burnout, and turnover (Acker 1999;Arches 1997;Lu et al 2002;Mechanic 2007;Feldman 2001;Shera 1996;Stone 1995;Tyler and Cushway 1998).…”

Inter and Intra Professional Social Work Differences: Social Works Challenge

“…Academia is challenged to incorporate these elements into MSW programs (Brooks and Riley 1996;Schamess 1996). Shera (1996) challenges graduate schools to educate future social workers with information and skills to survive in the evolving culture of managed care. Shera further proposes that social workers have an opportunity to provide leadership in the design, implementation and monitoring of managed care for people with severe mental illness.…”

“…This writer proposes that most social workers, regardless of their loyalty to differing professional views, disagree with the overwhelming power structures of the medical, pharmaceutical, insurance and licensing institutions. As a profession we need to be qualified to work ''within and against'' (Mullaly 1997) these oppressive forces while providing leadership in the design and implementation of managed care for people with severe mental illness (Shera 1996).…”